Phase 2 Study of Atorvastatin Safety and Antitumor Effects in Non-Hodgkin's Lymphoma

• ClinicalTrials.gov Identifier: NCT00185731
• Recruitment Status: Completed
• First Posted: September 16, 2005
• Results First Posted: December 2, 2017
• Last Update Posted: December 2, 2017
• Sponsor: Dean Felsher
• Collaborators: The Leukemia and Lymphoma Society; Damon Runyon Cancer Research Foundation; Burroughs Wellcome
• Information provided by (Responsible Party): Dean Felsher, Stanford University

Study Description

Brief Summary:

This is an approach which can inflict significant toxicity. An alternative is to block expression of oncogenes which are over-expressed only in cancer cells, a therapeutic approach which could reduce toxicity to the host while maximizing destruction of the oncogene-dependent malignant cells.

Condition or disease	Intervention/treatment	Phase
Leukemia; Lymphoma, Non-Hodgkin	Drug: Atorvastatin	Phase 2

Detailed Description:

Atorvastatin has been shown to decrease levels of active oncogenes in preclinical studies with murine and human lymphoma cell lines, and administration of statins leads to shrinkage of lymphoma in murine models. Therefore, it may be possible for atorvastatin to decrease levels of active oncogenes in human lymphomas. Further, upon decrease in levels of active oncogenes, human lymphomas may regress. Atorvastatin is a commonly prescribed drug for hypercholesterolemia: targeting the 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase enzyme may also be a way to decrease activation of oncogenes in human lymphoma, with minimal toxicity. For human low grade non-Hodgkin lymphoma, no curative treatment is available; therefore new, non-toxic and targeted therapies are sought for this disease.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 25 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase II Study of Atorvastatin in Patients With Low Grade or Refractory Non-Hodgkin's Lymphoma
• Study Start Date: April 2005
• Actual Primary Completion Date: November 2012
• Actual Study Completion Date: November 2012

Arms and Interventions

Arm	Intervention/treatment
Experimental: 80 mg Atorvastatin; Atorvastatin, 80 mg tablet, will be taken orally by the patient daily, beginning on study day 1.	Drug: Atorvastatin; 80 mg orally once daily; Other Name: Lipitor

Outcome Measures

Primary Outcome Measures :

1. Tumor Apoptosis [ Time Frame: 1 year ]
   Expressed as the number of participants whose tumor cells showed an increase in apoptosis during atorvastatin treatment

Secondary Outcome Measures :

1. Correlation of Tumor Apoptosis to Clinical Response [ Time Frame: 1 year ]
   The validity of tumor apoptosis as a biologic endpoint was assessed by correlation to clinical response. A correlation substantially less than 1 is interpreted as a poor correlation, while a correlation near +1 or -1 is interpreted as a strong correlation.
2. Atorvastatin Toxicity [ Time Frame: 1 year ]
   Assessed as the number of study participants with atorvastatin-related serious adverse events (SAEs).

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• > 18 years old

• Disease criteria: Confirmed by Stanford Pathology to be one of the following Non-Hodgkin's Lymphoma (NHL) subtypes:

  • Chronic lymphocytic leukemia /small lymphocytic lymphoma (CLL/SLL)
  • Extranodal marginal zone B-cell lymphoma
  • Nodal marginal zone B-cell lymphoma
  • Splenic marginal zone B-cell lymphoma

• Treatment criteria

  • Untreated: watchful waiting currently appropriate (includes CLL stage 0) o OR
  • Prior treatment: watchful waiting currently appropriate o OR
  • Refractory disease

• Staging within 4 weeks prior to enrollment (SLL, marginal zone lymphoma)

  • CT chest (date)
  • CT abdomen (date)
  • CT pelvis (date) OR

• Staging within 4 weeks prior to enrollment (CLL: CT not required)

  • Total white blood cell count (WBC) (Value) (date)
  • Absolute lymphoma cell count (ALC) (Value) (date)
  • Measurable disease (Site) (Size) OR
  • CLL (only): elevated absolute lymphoma cell count

• Disease amenable to biopsy (must check at least one):

  • Circulating tumor cells
  • Positive bone marrow
  • Palpable involved site (such as lymph node) measuring > 1.5 cm
• Eastern Cooperative Oncology Group performance status <2 (Karnofsky >60)
• Life expectancy of greater than 3 months

• Patients must have adequate organ and marrow function

  • Absolute neutrophil count > 1,000/uL
  • Platelets > 30,000/uL
  • Total bilirubin within normal institutional limits
  • Aspartate aminotransferase (AST) / alanine aminotransferase (ALT) ratio < 2.5 x institutional upper limit of normal
  • Creatinine within normal institutional limits OR creatinine clearance > 60 mL/min/1.73 m² for patients with creatinine levels above institutional normal.
• Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Women of child-bearing potential must have negative BetaHCG at enrollment

Exclusion Criteria:

• Chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study
• Not recovered from adverse events due to agents administered more than four weeks earlier
• Has stable low grade lymphoma has had rituximab within 3 months Patient with relapsed or refractory disease has had rituximab within 1 month
• Not recovered from adverse events due to surgery performed 4 weeks earlier
• Receiving any other investigational agent. Known brain metastases
• Taken any statin within the past 6 months prior to enrollment in the trial
• Currently abuses alcohol
• Currently takes cyclosporin or gemfibrozil Patient has a prior history of rhabdomyolysis
• Has uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
• Pregnant: Patients are not excluded if they are breastfeeding at the time of enrollment, but breastfeeding should be discontinued if the mother is treated with atorvastatin.
• HIV-positive patients receiving combination anti-retroviral therapy

Contacts and Locations

Locations

United States, California

Stanford University School of Medicine

Stanford, California, United States, 94305

Sponsors and Collaborators

Dean Felsher

The Leukemia and Lymphoma Society

Damon Runyon Cancer Research Foundation

Burroughs Wellcome

Investigators

• Principal Investigator: Dean Felsher; Stanford University

More Information

• Responsible Party: Dean Felsher, Associate Professor, Stanford University
• ClinicalTrials.gov Identifier: NCT00185731
• Other Study ID Numbers: IRB-13683; 4328-07 ( Other Identifier: Damon Runyon Cancer Research Foundation ); 95140 ( Other Identifier: Stanford University Alternate IRB Approval Number ); LYMNHL0020 ( Other Identifier: OnCore )
• First Posted: September 16, 2005
• Results First Posted: December 2, 2017
• Last Update Posted: December 2, 2017
• Last Verified: October 2017

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No
• Product Manufactured in and Exported from the U.S.: No

Additional relevant MeSH terms:

Lymphoma; Lymphoma, Non-Hodgkin; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Immune System Diseases; Atorvastatin; Anticholesteremic Agents; Hypolipidemic Agents; Antimetabolites; Molecular Mechanisms of Pharmacological Action; Lipid Regulating Agents; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Enzyme Inhibitors